Individual
LUCRETIA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
664 E 130TH ST, CLEVELAND, OH 44108-2029
(216) 255-0419
Mailing address
664 E 130TH ST, CLEVELAND, OH 44108-2029
(216) 255-0419
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
05/08/2022
Last updated
05/08/2022
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